HC Deb 30 May 1968 vol 765 cc2231-62

7.36 p.m.

Mr. Laurence Pavitt (Willesden, West)

I beg to move, That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges for Drugs and Appliances) Regulations 1968 (S.I. 1968, No. 759), dated 13th May, 1968, a copy of which was laid before this House on 17th May, be annulled.

Mr. Speaker

Perhaps it would be convenient to discuss at the same time the second Prayer: That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges for Drugs and Appliances) (Scotland) Regulations 1968 (S.I. 1968, No. 818), dated 20th May, 1968, a copy of which was laid before this House on 23rd May, be annulled.

Mr. Pavitt

I oppose the whole of these Regulations, but the main section to which most of my comments will be addressed are those contained in section 3 of these Regulations which place the charge of 2s. 6d. on every item of prescription. I still find it absolutely incredible that in the light of its history since 1951 a Labour Government should now seek to tax the sick; and I repeat this is a taxation measure and nothing else but a taxation measure. In spite of the exemptions, the sick and disabled will be the people caught by the taxation. The healthy people will be entirely free without any question of making application for exemption.

I believe that this occasion is one of the saddest since I have been a Member of this House. For me it marks the end of a battle which started six months ago when I fired the first defensive shots in a letter to the Daily Telegraph dated 15th December last. Since then I have moved Heaven and earth to avoid this clash this evening on the Floor of the House. I have tried through all channels and in all possible ways to get the Government to change their mind on these Regulations which are before the House. I particularly made representations to my colleagues in the Government and I was on the telephone to my right hon. Friend the Minister of Health even before the decision was finally announced on 16th January last.

At one time when I had the support of 150 back-bench colleagues I was, I believe, within an ace of success, but my ace was trumped. A miss is as good as a mile and tonight we are faced with the fact that this charge, which is opposed to all the precepts in which I have believed all my life, is before the House. I am sad for myself but I am sad also for my right hon. Friend because with him shoulder to shoulder I fought the battle very solidly until 1964 against these Regulations ever appearing before the House of Commons. My right hon. Friend the Minister has made the greatest achievement in the National Health Service of any Minister since 1951. Not least I pay great tribute to him for something which many hon. Members may not realise, the tremendous job he did, very quietly and with no ostentation at all, when in February, 1965, we had three out of every four family doctors with their resignation in when he yet secured not only the retention of the family doctor service but made the first advances towards health centres that had been made for some 15 or 16 years.

Yet it is because of this one appalling error of judgment contained in this decision that I am sorry for my right hon. Friend because he will go down in Labour Party history not as the man who has done so much but as the man who reversed the principle that for the sick and the disabled in time of trouble there would be no additional financial difficulties and the service would be free. I know the dilemma he is in. He was faced with the choice of two evils. I know the justification he gives for his choice which I believe was entirely and utterly wrong. I will give a quotation from a comment of a Minister of Health: In the present financial emergency, I have to see whether there can be any increased contribution from the Health Service or any saving on expenditure. I have looked round the whole of the branches of the service. We are constantly trying to avoid wasteful expenditure;, and I am quite certain that there is no possible way of reducing expenditure, without closing beds or reducing service, except the present alteration of the prescription charge."—[OFFICIAL REPORT, 28th November, 1958; Vol. 561, c. 710.] But that was said by a previous Minister of Health, the right hon. Gentleman the Member for Thirsk and Malton (Mr. Turton). When my right hon. Friend had to make his decision he was not making it as something fresh but as something with which he had lived ever since 1951; and these Regulations are based on the arguments that took place at that particular period. I said it was wrong to pass these Regulations from my party's point of view. I say that because of the history of the Health Service since the time when Somerville Hastings first started to promote the scheme in 1934, until such time as the late Nye Bevan managed to get it on the Statute Book in 1946 with the appointed day in 1948.

This Order reverses the policy of my party which has been held firmly ever since 1st May, 1952. Again I quote from the OFFICIAL REPORT. The Minister of Health at that time said: Looking at all these Measures together, the 1949 Act, the 1951 Act and this Bill of 1952, on behalf of my right hon. and hon. Friends I say that when we are returned to power we shall take steps, as soon as Parliamentary opportunity permits, to bring all these charges —charges for drugs, medicines, appliances, dentures, dental treatment and spectacles—to an end."—[OFFICIAL REPORT, 1st May, 1952; Vol. 499, c. 1776.] The right hon. Gentleman, Mr. Hilary Marquand, made that promise on behalf of Mr. Attlee and the Government at the time, and the rest of us who fought for the Health Service have ever since had that as our creed; and yet these Regulations contravene that undertaking. There have been further evidences and I should like to quote again from the OFFICIAL REPORT, when my right hon. Friend the Prime Minister resigned from the office he then held. On that occasion he said, referring to Measures then being taken comparable to the Regulations we are seeking tonight to annul: It carries with it, in a time of rising prices, the danger—I should have said the certainty —of further erosion of the social services as year succeeds year. The principle of the free health service has been breached, and I dread to think how that breach might be widened in future years."—[OFFICIAL REPORT, 24th April. 1951; Vol. 487, c. 229.] It is because of my fear in precisely the same terms and for precisely the same sentiment that I am tonight determined to resist these Regulations to the utmost of my ability. I give a further quotation from the OFFICIAL REPORT, from a person who for many of us was the walking example of what we meant when we talked about compassion for the sick, my late right hon. Friend, Nye Bevan. On that occasion he said: I have been accused of having agreed to a charge on prescriptions. That shows the danger of compromise. Because if it is pleaded against me that I agreed to the modification of the Health Service, then what will be pleaded against my right hon. Friends next year?"— I suppose had he had pre-vision he could have said "in 1968". Indeed what answer will they have if the vandals opposite come in? What answer? The Health Service will be like Lavinia—all the limbs cut off and eventually her tongue cut out, too. Nye Bevan went on: Those who live their lives in mountainous and rugged countries are always afraid of avalanches, and they know that avalanches start with the movement of a very small stone. First, the stone starts on a ridge betwen two valleys—one valley desolate and the other valley populous. The pebble starts, but nobody bothers about the pebble until it gains way, and soon the whole valley is overwhelmed. That is how the avalanche starts, that is the logic of the present situation, and that is the logic my hon. and right hon. Friends cannot escape.—[OFFICIAL REPORT, 23rd April, 1951; Vol. 487, c. 42.] I wish that I had the eloquence of my late right hon. Friend. His remarks say more in a sentence or two about these Regulations than I could possibly put into words. Must we make the same mistakes twice? Does my party have to learn its lesson the hard way and go through all this again? These Regulations are wrong on health grounds, on grounds of social justice, on economic grounds and on political grounds.

They are wrong on health grounds because they will act against early diagnosis, which is the only way by which we can save money and lives in the Health Service. We must diagnose the lump on the breast before it becomes a cancer. We must ensure that the lump is seen by the general practitioner. Nothing deters one from going to the doctor more than a simple excuse not to go, and I fear that the Regulations will provide such an excuse.

They are wrong because they encourage self-medication. I know of only one death which occurred from this, and that happened at the time when prescription charges were last in being. Those charges were removed on 1st February, 1965, to the eternal credit of my right hon. Friend the present Minister. A person with a coronary thrombosis must take what is known in medical circles as T.N.T. tablets for the rest of his life. When the prescription charge was 2s. one could get 100 of these tablets for 1s. 6d. The death of which I speak occurred because the man in question did not bother to get his E.C.10 prescription. He decided that, to save time and money, he would buy the tablets himself and pay the 1s. 6d. Having not bothered to go to the general practitioner, he was not getting his regular checks when going for his tablets, but his heart had deteriorated, and he died. I know of only that one case, but it is one too many.

On the question of social justice, why single out the sick and the disabled to pay? People in working class areas pay three times as much as people in residential areas because they go to their G.P.s three times as frequently. Why make it, "The more ill you are, the more you pay and the less ill you are, the less you pay"? This is an affront to social justice.

I make a particularly strong appeal for the middle aged woman, particularly when at the time of the menopause. When I was a kid in East London mother could never be ill. Father could because Lloyd George had provided him with the National Insurance Scheme. The kids could because no mother would see her child needing medicine and a doctor without providing them. But mother at the change of life suffered pain and discomfort, had to grin and bear it, because she could not afford to go to the doctor. The great emancipation occurred as a result of Nye Bevan's Act of 1946, which made it possible for the ordinary working class mother to see the doctor and no longer have to bear pain in that way. It was an excellent emancipation because she had been, in the main, the one person in the community who had to suffer.

If prescription charges are imposed, the average mother in working class areas may well decide on Thursday night, if it is a question of buying a meal or buying a prescription—because on Thursday night, the night before the week's pay comes in, there is not much money to spare—to provide a meal for her family and go without medicine for herself.

On these grounds, the Regulations are totally and horribly wrong. For 10 years we pay perhaps as much as £370 in taxation against the day when we are ill, and then we are ill for, say, three months and money is short—we pay a second time for that illness because it is not one of the designations of my right hon. Friend. But in an affluent society this may be a greater disaster than it was in the unemployed 'thirties because now one drops out, so to speak. One cannot keep up the payments on the television and it goes back to the shop. One's children at school cannot talk about the programmes they saw on the "telly" last night. They are dispossessed. Even in an affluent society, illness can add to difficulty, and these Regulations heighten that difficulty. For the first time in 20 years, financial and mental anxiety can now accompany the problem of trying to deal with sickness.

There is no need for me to go into the question of whether or not the Health Service is abused—though some people pay a lot of attention to this question. These Regulations will be the hypochondriac's charter—the person whom the G.P. calls his "Monday morning special". We are not sure why this category should be particularly prevalent on Monday mornings, but the reason is probably because that is the day when she feels most in need of a prop to face the coming week. She can now hand over her half-crown for her medicine, whereupon she has got an entitlement bought and paid for. Even more of our doctors' time will be taken up in this way.

As for Section 5 of the Regulations, my sympathy goes out to the poor rural practitioner who dispenses his own medicines. His relationship with his patients is bound to suffer. A person will go for treatment and the G.P. must say, "Until you give me your half-crown, I cannot give you your medicine." What a paltry sum when one cannot employ a plumber for less than 30s. or an electrician for less than 45s. The patient does not realise that the half-crown is merely the payment for the E.C.10 prescription form. The relationship between doctor and patient, particularly in rural areas, is bound to suffer and the present good relationship that exists will go for a burton.

The argument that Regulations of this kind are needed to stop abuse is entirely wrong and in 1959 the Lancet published an interesting article which pointed out that, considering the whole history of prescription charges, once one puts an economic basis between patient and doctor one is making a nonsense of the system because there is no financial benefit in the long run and, if there is, it is nothing like what the economists thought it should be.

On 16th January, when the first intimation was made in the House that Regulations of this type would be coming in—we listened in shocked silence to that announcement—one undertaking was given by my right hon. Friend. He said that this time it would be different from the arrangements introduced by the Tories. I give full credit to the Minister of Health because if anybody can perform this sort of exercise in a humane way, it is he. He has shown that he is willing to do everything possible with this evil to make it less evil. Nevertheless, the claim was that there would be exemption for the chronic sick, and most of us expected that all chronic sick would be exempt.

As my right hon. Friend knows —because the doctors would not agree to co-operate—only four clearly defined cases of chronic sick are exempt and at least 60 cases are not. I invite hon. Members to examine the OFFICIAL REPORT for 30th April, in which they will see 44 such cases quoted in Parliamentary Questions to my right hon. Friend. They were all cases of people suffering from acute illnesses, schizophrenics, people who had had angina and people requiring medication for the rest of their lives. All these people are not exempt, although we hope that some amelioration will be given later by some arrangement.

The Regulations should be withdrawn because the Government gave an undertaking which they found they were unable to fulfil. Many chronic sick are not exempt and that is a good reason—not a good excuse—why the Government should have second thoughts and say, "We will withdraw this Instrument until we are able to fulfil the solemn undertaking we gave". I hope that, for this reason, the Regulations will be annulled.

At this stage I have four questions to ask my right hon. Friend. They concern costing. An announcement has been made about the way in which some of the exemptions will be made. There will be a system of sample checking by the Ministry to ensure that there is no cheating. What will be the cost of this? How many staff will be involved in the necessary checks which the Minister will have to do under the Regulations to prevent people from cheating?

Secondly, how many more staff will be required and what will be the cost in the pharmacy departments of hospitals and elsewhere to operate the scheme which we are discussing under the Regulations? Third, the tremendous advertising campaign in the national papers like the Daily Telegraph, the Observer, The Times, the Sunday Times, and so on— what has been the cost of that enormous campaign?

Finally, what has been the total cost of the scheme, which at one time was estimated at about £800,000 to £1 million to run, in the light of the present arrangements with pharmacists and doctors? What is the total cost of operating this scheme?

These Regulations are wrong, because they are a complete misconception of what the National Health Service is all about. For 20 years we have been seeking to achieve prevention of illness rather than the cure of people who are sick. When we had a Labour Government in 1964, when, in particular, my right hon. Friend was made Minister, there was great jubilation among those of us who had the Health Service at heart, because we knew he would do his best to advance the 20 year old Health Service to the next stage. These Regulations move backwards towards the curing of illness; they are not a help towards prevention. Hospitalisation in a hospital for the acutely sick in my area costs £46 a week for every patient. In the hospital closest to this hotel—[Laughter.]

Mr. David Winnick (Croydon, South)

Hospital.

Mr. Pavitt

I have been on the Committee on the Finance Bill and for three days arid nights I have been sleeping and living in this place, and if I have mistaken its function it can hardly be surprising.

The attitude on this side of the House has never been that we spend on health: we invest in it. What we do is to safeguard the health of the community so that it can do all the things we want. We do not think of it as an expense and a loss but as giving the right treatment so that people are not off work and are not away for a fortnight if they can be cured in three days. Ours is the attitude which realises and seeks to alter the sort of situation where more time for production is lost through illness than through strikes. Since 1964 we have lost through strikes 3 million days, on the average, most years. Last year it was only 2.7 million of days of production lost, but last year something like 100 times more was lost through illness. For every one day of strikes 100 days' production were lost through illness.

To produce Regulations like these just prevents people from getting cured. They put a barrier to early diagnosis to speed cure. What nonsense it is, therefore, to come up with Regulations like these to save £25 million in present economic conditions when we ought to be taking large strides in the opposite direction.

In previous discussions here and elsewhere one reason given for why the Government are doing this is that possibly the general public accept it, that there is not a great deal of opposition to it amongst ordinary people. I accept my share of responsibility in that regard. All of us on this side of the House have failed to explain to the people what the Health Service is all about. There is a misconception that it is free. It is not. The average father of a family spends £37 a year on it. Since 1948 and the appointed day most of us have paid £800 into the Health Service, in order to build the hospitals and pay the nurses and pay the doctors and to look after the people of this nation. The average father of a family spends more on two items for his car, his insurance, and his road tax, than he pays for the health of the whole of his family for the whole of a year. And yet in the Labour Party we have failed to identify the ordinary person with this Health Service, which is his. It is not ours, it is not the Government's. It is something which belongs to us all, to the average person. The nurses, they are our nurses; we build our hospitals. Yet there is this conception that the Health Service is something which is for free. It is something which we the people have built with a good deal of effort and and a good deal of strain.

So on this occasion I say again what I said when the announcement was first made about these Regulations by my right hon. Friend. These Regulations undermine my faith, the faith of a lifetime. My Government have in their team an abundance of ability and of intellectual capacity, and a tremendous amount of integrity, but by these Regulations they have shown a lack of imagination, a lack of vision, a want of fire in the belly which inspired most of us to join the Labour movement. In the Labour movement we have had, the thousands and thousands of foot sloggers in the constituencies, the people who go out and get their feet wet in the service of the movement. It was Nye and the Labour Government who from 1945 to 1951 built on that faith.

Everything rested on the achievements of those days. Nye Bevan clothed very dry as dust legislation with the magic of the brotherhood of man and compassion for the people who needed it. Nye Bevan brought the Act to the Statute Book in a piece of legislation where we put a Socialist principle into legislation to make a practical reality of the hopes and aspirations most of us have so long had. Nye Bevan was a creative dreamer. He saw what many of us also saw, and what he saw was the vision of a kind of world in which there were human relationships, the world we believed in, and be made a practical reality, not just for Parliamentarians, but for the humble —but also for the rich; rich or poor, it did not matter, if there was pain to be relieved.

I have said this before and said it of the right hon. Gentleman with whom I have crossed swords, one of the most brilliant Parliamentarians in the House, the right hon. Member for Enfield, West (Mr. Iain Macleod). I see that he suffers sometimes from pain, as many people do. I do not care if he is a millionaire. If I can help relieve his pain by contributing to the Health Service I am glad to do so, for it is the element of compassion that matters and I would offer it to anybody. This was the starting point for many of us, the establishment of brotherhood and compassion, and for many of us it was the starting point for activity in politics. These regulations we are discussing tonight take away just that element of compassion and the hope of moving towards a Socialist society.

Even with the Regulations we shall still have the best Health Service in the world. Make no mistake about that. But it will no longer be as Socialist as it was and should be. It will be a Socialist body in which a Tory heart is transplanted. Even if rejection does not take place immediately and tonight, it will no longer provide the inspiration without which the Labour Party itself will die.

The decision we take tonight can in no way be regarded as a vote of no confidence in my Government—in my Government of whom I am proud in spite of present difficulties. These Regulations represent 1½ per cent. of the total Health Service bill for this year, apart from other Government expenditure. If anybody pretends that this is a matter of confidence I can only say that that is just absolute arrant nonsense. I bow to none in this House in my support of this Government and particularly, with his heavy burden, my right hon. Friend the Prime Minister. I supported him in 1960 when it was an unpopular thing to do. I supported him in 1964 when it was a very popular thing to do. I support him now because I think he has done a tremendous job for my party and I do not envy him the hard, tremendous decisions he has to take.

I may lose this battle only to continue the war. I believe that it will be significant to the future of my party and all of us here that on 30th May, 1968, a body of Labour M.P.s, few or many, recorded a vote that a Health Service which was Socialist in concept should remain Socialist in practice. My hon. Friends must decide for themselves what action they take. I have no option. On this matter I shall divide the House and do what I think right, not because it satisfies my conscience, but because it is right for my party.

8.11 p.m.

Dame Joan Vickers (Plymouth, Devonport)

I congratulate the hon. Member for Willesden, West (Mr. Pavitt) on his sincerity. He and I have worked together on a Private Member's Bill, and I should like to congratulate him on getting that through. I am certain that this must be one of the Minister's saddest days. I have supported him, too, on a Private Members' Bill, and I know many of his ideas on these matters.

However, I want to ask one or two practical questions. When the Health Service charges were first put on by a Conservative Government, I abstained, but I voted on the second occasion when there was a chance of getting the money back, and I still prefer that scheme to this, because I think that this is illogical. How much money is really being saved? The hon. Member mentioned the advertisement, but I should like to know whether the advertisement is also appearing in some provincial papers, because my constituents cannot afford to buy the Daily Telegraph. They probably would not want to read it if they could. Is the advertisement appearing in the Daily Mirror and the Western Morning News, or the Western Evening Herald, which goes into one in every four houses in Plymouth?

What will be the cost of the token books and leaflets? The leaflet Form PC11 measures 6½ by 4½ inches. One doctor has already written to the newspapers to say that intelligent patients may be amused by the form, but that the elderly will be unable to read the tiny print and the unintelligent will be utterly bewildered. If we are to have this scheme, and presumably we are, what is the good of sending out a leaflet which will be unintelligible to the people whom we most want to help?

Why should the arbitrary age of 15 be chosen for schoolchildren? We hope that many children, particularly those from poorer families, will stay on at school until they are 16, and it is the poorer families about whom I am worried. I know that there are 11 million children under 15, but would it not have been better and slightly more selective and a help to the lower income groups—which contain the children whom we want to stay at school until the age of 16—if all children under the age of 16 had been exempted, except those whose parents could afford to pay for them to go to grammar school?

What is the point of the age of 65 for all persons? There are many single women and widows who have just enough to live on with their pensions, but who will not be eligible and who will have to wait until they are 65 before they can get any help. I am not at all happy about the situation of unmarried mothers. An expectant mother, according to the advertisement, has to go through a terrific rigmarole to get help. She has to apply for welfare milk tokens and her application has to be sent to the Health Service Executive Council. Are we certain that all this can be kept private? Such a woman will be nervous about making an application.

I have been interested by the list of diseases. Does the right hon. Gentleman think that it is compassionate that people should always know from what type of disease they may be suffering? I am not a doctor, but there are many doctors in the House, and I should have thought that to be told that one had one of these diseases might militate against an improvement in health, and the patient might even learn that his disease was incurable.

The hon. Member for Willesden, West mentioned one group of patients who are incurable, the chronic sick. These are not included, but I should have thought that everybody had been moved by the Disablement Income Group to think that they should have some kind of pension, and yet they are now to be made worse off than ever before.

Is the list final? Even though there is now a cure for tuberculosis, T.B. and asthma are often permanent diseases and surely people in the throes of tuberculosis need help. Will the right hon. Gentleman consider adding to the list if that is necessary?

The advertisement says: The Ministry of Social Security will send you"— an exemption certificate— with your next order book. The advertisement says: If you have an order book you don't have to apply for an exemption certificate". How will the National Health Service Council know if and when to send a new one? Will there be, as in a cheque book, a form to remind them, because they will not know how many prescriptions a week they may require, and I do not see how they will know when to send for the next form.

The advertisement says: Form PC. 11, available from any post office or Ministry of Social Security local office, explains who may claim and how to do it. Are Post Office officials to be informed how to fill in these forms? If so, will not that create a lot of work and difficulty?

The advertisement refers to war pensioners. Does this refer only to Service pensioners or does it include, for instance, civil defence pensioners? It says: Those awaiting an exemption certificate from the Executive Council will have to pay the charge, and claim a refund after the certificate arrives. In certain areas, it may take a long time to arrive. How long is it expected people will have to wait?

The Regulations say: a continuing physical disability which prevents the patient from leaving his residence except with the help of another person … will be exempt. How is this to be defined? A blind person often cannot go out without the help of another person, but he is not necessarily sick. The whole scheme is very illogical.

The advertisement says: If you require numerous prescriptions, but are not entitled to exemption or refund, it may later be possible for you to buy a card entitling you to pay no further charges for a period of time. I know that this provision is not to be implemented at once, but I should like to know why it has been included in the advertisement and what it means. Who is to be covered and how does one buy a card? This is an extraordinary situation.

I am very disturbed by these Regulations, because the low income groups and single women and widows under 65 will be hit as usual by this Government. I hope that the right hon. Gentleman will give us some indication of how he means the scheme to work and some indication that his mind is not completely shut to further alterations if they prove necessary.

8.20 p.m.

Dr. A. D. D. Broughton (Batley and Morley)

I begin by repeating an opinion which I have voiced in the House on a number of occasions, namely, that in principle I favour a free National Health Service. 1 know that I am not alone in holding that view. It is shared by my right hon. Friend the Minister of Health and by my hon. Friends. My reason is that I regard a free Health Service as being necessary to ensure that no financial obstacle stands in the way of any patient needing treatment. But I realise that we cannot have all we want regardless of cost.

Our country is faced with economic and financial problems, and it is imperative that cuts be made in Government expenditure. The Health Service is a heavy expense on the Exchequer, and the Government have decided that it is not unreasonable, in the present difficult circumstances, to cut down on some of the cost. I am sure that every item of Government expenditure has been examined, and the decision has been reached to save on prescription costs. I very much regret the imposition of these charges, but I feel that I must accept them as necessary at present. It is my hope that our country will soon reach a position of economic prosperity and financial stability and then be able to afford to abolish these charges.

Having expressed my opinion on prescription charges, I wish now to examine the Regulations in relation to one or two points which I have in mind. When the announcement about the imposition of prescription charges was made, every hon. Member knew that certain categories of people would have to be exempted. Paragraph 7 of the Regulations gives the list, and it includes persons under 15, aged 65 and over, expectant and nursing mothers, those in receipt of supplementary allowance, and those suffering from certain chronic diseases and continuing disability.

The list is very good as far as it goes. But why was the age of 65 selected for both sexes? It may well be the right age for men, but 60 is regarded as the retirement age for women. If a retirement pension is payable to women at the age of 60, why not exempt them from prescription charges at that age? This matter has been mentioned already by the hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers) and I request my right hon. Friend to look at it again and to see his way to granting women of 60 years of age and over free prescriptions. I am sure that they are deserving of this small kindness.

I was surprised to find that persons suffering from tuberculosis are not included in the list of exempted persons. My attention was drawn to this omission by a consultant chest physician who treats patients in my constituency. He wrote to me saying: I am concerned about the imminent imposition of charges for prescriptions. I understand that anti-tuberculosis drugs will not be exempted. All tuberculous patients have, of course, to continue these drugs for a period of one and a half to two years and take not less than two and usually three at a time, and also, of course, the cure of the disease depends on taking the drug for this length of time. The incidence of tuberculosis is highest in the poorest sections of the population. He went on to say: It is difficult enough in many cases to get the patient to continue taking the drugs for this length of time even when they are given free. He concluded: I feel that the present good progress in the eradication of tuberculosis will be prejudiced if these drugs are not included in the list of exemptions and I am writing to ask if you can help in this. A similar letter was written by that consultant to my hon. Friend the Member for Dewsbury (Mr. Ginsburg) with whom I have discussed the problem. I know that my hon. Friend sent his letter to the Minister. Therefore, my right hon. Friend will be acquainted with the problem. He will have had an opportunity to give it thought, and I hope that I shall receive a satisfactory answer this evening.

I am aware that the present list of exempted persons will allow exemption for some, and perhaps most, cases of tuberculosis—for example, those cases occurring in persons under 15, or 65 and over, pregnant women and persons drawing supplementary benefit. But the consultant who wrote to me and to my hon. Friend the Member for Dewsbury is right in thinking that not all tuberculosis patients will be covered by the present exemptions.

I say emphatically that I consider that it is of vital importance that all drugs needed for the treatment of tuberculosis should be supplied to patients free of charge. This is necessary partly for the patient's sake, but also, and particularly in cases of pulmonary tuberculosis, to protect others from the spread of a serious, deadly and infectious disease.

While considering this matter, I have thought about patients suffering from other infectious diseases. I will not weary the House by going through the list and giving details of them. But I urge the Minister to include all cases of notifiable disease among the exemptions. I regard that as advisable and, indeed, as necessary to keep down the spread of infectious disease. Compassionate feeling for certain categories of people has been shown in compiling the list of exemptions, but it appears that the need to protect the community from infectious disease may have been overlooked. I repeat my urgent request that all who suffer from any notifiable disease be exempted from paying prescription charges.

8.29 p.m.

Mr. Philip Holland (Carlton)

I endorse what the hon. Member for Batley and Morley (Dr. Broughton) has said and I support his argument. Before I do so, I feel that it is my duty to confess to the hon. Member for Willesden, West (Mr. Pavitt) that I have been guilty this week of the sin of self-medication. This was not due to the imminence of Health Service charges but rather to my strong attraction to the enchanting hotel to which he referred, which has precluded me from spending time in my own doctor's surgery. I am sure that he will not expect me to go all the way in agreement with everything he has said, but I do agree with some of his points. I propose to keep what I have to say very short, because one of the by-products of a cold in the head and a throat infection is that it is difficult to concentrate, and if one goes on for too long nonsense results.

My constituency encompasses three coal-mining areas, and I have a special interest in pneumoconiosis and other respiratory diseases which are caused by dust and which afflict those who work underground. I am surprised that these notifiable diseases have not been included in the exemptions.

I do not confine my plea to the pneumoconiosis group of diseases. The Min- istry of Social Security Leaflet N.I.2 lists 44 notifiable diseases, including tuberculosis. Two more are listed in the leaflet N.I.3, and they are pneumoconiosis and byssinosis. I cannot understand why the right hon. Gentleman has not included in the exemptions a clearly defined area of hardship. Many of these diseases are disabling, but not totally disabling. They result in suffering and also in reduced earning capacity. I should have thought that this group of diseases was an obvious area of hardship. Surely, the essence of having exemptions is to try to categorise hardship. I am sorry the right hon. Gentleman has not included these diseases, and I support the plea of the hon. Member for Batley and Morley for them to be included. I am sure that a way can be found if the Minister has the will to do it.

I too have had a letter about tuberculosis from a consultant chest physician in a hospital which serves my area of Nottinghamshire. He said much the same as the consultant chest physician said in the extract from his letter which was read by the hon. Gentleman the Member for Batley and Morley. I quote the last paragraph of the letter which I received: The incidence of tuberculosis in this country has declined enormously and is still falling. It would seem unfortunate if this should be impeded by the imposition of prescription charges. I echo those words. It will indeed be unfortunate if the imposition of prescription charges and the failure to exempt a clear area of hardship impedes the early treatment of those disabilities, the neglect of which in the early stages can have such devastating consequences.

I too have sent a copy of this letter to the Parliamentary Secretary, and I hope that we may have a response to this plea, but, please, not only to the plea for the tuberculosis patient but to the plea for the notifiable diseases across the board. I am sure that this is an area which can easily be identified as an area of hardship, and these are the people who should be exempt from charges.

8.33 p.m.

Mr. Alex Eadie (Midlothian)

Since it was the will of the House that both Regulations should be taken together, I wish to speak to them and to comment on how Scotland will be affected by prescription charges. I believe that the Scots aspect must be considered, although the effect and implications will be the same. I will not repeat the argument already made against the imposition of prescription charges. In my opinion, this is a breach of principle for my party. Try as we may, we shall never escape from the logic that prescription charges are a tax on the sick and injured who will not be covered by any exemption.

The Minister of Health will try, I am sure, to administer the proposed change with compassion and understanding. Indeed, I understand that about 50 per cent. of the people of Scotland will be covered by exemptions. No doubt that can be confirmed by the Minister. However, the introduction of exemptions is bound of itself to create anomalies, because of the difficulty of definition. Although the debate has just begun, anomalies are already beginning to show themselves.

Perhaps I may give one example in a little more detail. I have said repeatedly that, before I came to the House, I had been a coal miner for 30 years, and I am proud to be able to say that. My right hon. Friend will recall that, when the possibility of prescription charges was first announced by the Government, I put down a number of Questions about pneumoconiosis and silicosis.

It is assumed by the general public that miners and other workers who are pneumoconiotics are unable to continue working. I do not want to debate the merits or otherwise of men continuing to work in mines when they have pneumoconiosis, but many do, and any medicine that they need is not just for their own personal comfort. They need it to keep themselves at work. As a result of this change of policy, they will have to pay to keep themselves at work.

A man who is able to keep at work is a source of wealth to the country, and I cannot understand why we should seek to undermine the man who wants to carry on at work and who, as a consequence, will have to pay to do it because he has pneumoconiosis. As has been said before, this is a tax on the sick.

Before I came to the House, one of the men working with me was a pneumoconiotic. Frequently, he had to leave work early, he was always taking pills, and he suffered all the time. He always had trouble with his chest. I cannot understand the logic behind a proposal which still taxes these people who, apparently, are not covered by any exemption.

However hard my right hon. Friend tries, the amount that an individual pays in prescription charges is largely determined by his occupation. I have had some experience of heavy industry, and I know that the work people engaged in it will have to pay more in prescription charges than those in other sectors. It is a curious situation and, when people come to recognise it, there will be bitter opposition and resentment among those employed in heavy industry.

I do not subscribe to some of the arguments which have been advanced. I feel that, sometimes, we tend to over-exaggerate the impact on the industrial sector of the announcement about prescription charges. I do not believe that people are yet indignant about this. I wish they were. The activists in our movement are indignant about it, but the people have not yet realised what it will mean when prescription charges are introduced.

I have grave doubts whether the scheme will be workable in Scotland. There is no secret that the pharmacists in Scotland are in dispute about the working of the scheme. The Minister must give the House more information about this when he winds up the debate. Today, I received a telegram from Scottish pharmacists. I shall read it because I think it pertinent to the debate. It is addressed to me and it says: Scottish chemist contractors have been unable to reach agreement in Whitley Council on payment for operating prescription charges scheme. Request you approach Secretary of State on chemists' behalf. Gladly supply further details by telephone. It is signed by the representative of the Pharmaceutical General Council in Scotland.

There are great reservations about how the scheme will be implemented. A constituent of mine wrote to me when the announcement was made. He is a practising pharmacist with a rather large business. He wrote: The charge is to the 2s. 6d. per item. I am presented, say, with a form which contains three items. I ask the patient for 7s. 6d. They reply that they have not got 7s. 6d.— could they hand it in later? What am I to do? Do I give them credit and never see them again or have I to be heartless and refuse them medicine which may be essential? Thus, I am subsidising the drug bill myself to the tune of 7s. 6d. Or the patient may say, ' I have only 5s. I will take two of the items and leave the third one. Why should I be placed in the position of deciding which items are essential and which are not? This is not my job—it is the doctor's. Believe me, these things really happened under the old scheme of charges and they will happen again. There speaks the voice of experience.

When we were discussing the implications of this scheme some of us suggested that the cost of administering prescription charges with exemptions would make a nonsense of the introduction of charges. The Minister has a duty to give us information this evening. I have tried by Parliamentary Question to find the cost. I found that in my area in 1967 the gross cost of prescription charges was £87,907. In a Question to my right hon. Friend the Secretary of State for Scotland I asked what the gross cost of prescription charges under the Health Service was. He informed me that in 1967 it was £16,344,250.

In HANSARD of 22nd May we were informed that the cost of exemptions in Scotland would be about £2.5 million. This brings us to a ridiculous state of affairs. We are entitled to know what the administrative cost of the scheme will be. We have not had the information yet, even though I and some of my hon. Friends have tried to get it. My hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) tried to get the information two days ago, and anyone who reads the Answer will find difficulty in understanding what it means.

Mr. Adam Hunter (Dunfermline Burghs)

My hon. Friend says that the exemptions in Scotland will cost about £2.5 million. As this represents about 50 per cent. of the people in Scotland, the total cost for prescription charges is only about another £2.2 million in Scotland.

Mr. Eadie

My hon. Friend has a good point. It emphasises what I said at the beginning of my speech, and it points out how ridiculous the debate is.

I want to deal with the important question of administration. It is difficult to get the costs. Perhaps we can get an inkling of what it will cost to implement this breach of principle through a Question answered on Monday, 27th May, by the Minister of Social Security. The reply was:

"The total administrative cost of my Department in the last financial year (1967–68) was about £94 million divided as follows:

£ million
Sickness benefit 17
Unemployment benefit 1
Retirement pension 21
Other national insurance benefits 5
Total national insurance benefits 44
Industrial injuries benefits 8
Family allowances 5
War pensions 4
Supplementary benefits 26
Administration on behalf of other Government Departments 7
Total 94

—[OFFICIAL REPORT, Monday, 27th May, 1968; Vol. 765, c. 154.]

The point I am trying to make is that the cost of administration will make this saving even more ridiculous. The Minister must be more forthcoming in his reply, and tell the House precisely what it will cost to administer the scheme. It is not clear for what period the exemptions will apply and to what conditions they will be subjected. Will it be made a condition of exemption that financial circumstances do not change? If so, what about those with fluctuating earnings? Will it be necessary to report any change, however small, to the Ministry? Will people commit an offence if they fail to do so?

I consider the Regulations to be unjustified. I do not believe that the Government can defend the indefensible and I must ask my right hon. Friend, even at this late stage, to announce that they will not proceed with what I believe to be a serious violation of principle.

8.50 p.m.

Mr. Brian Harrison (Maldon)

I do not think that there is anyone in the House who has not a great deal of sympathy for the right hon. Gentleman the Minister of Health, who finds himself in such a dilemma. He has frequently come out against the introduction of any form of charges on the National Health Service and now finds himself having to decide either to cut the Service in other directions or reintroduce prescription charges, which I must admit some of us feel should never have been removed in the financial situation which we are led to believe existed in 1964. While I feel sorry for the Minister of Health, I feel even more worried about the position of the Prime Minister in this situation, in view of his earlier resignation on just this issue.

I hope that the Minister of Health will keep a flexible attitude towards how the charges are to be collected and towards which diseases will be exempted. I draw his attention, in particular, to tuberculosis. Two very exciting things have happened since I first became interested in the health services, 16 years ago, and they happened within a few miles of my home and my constituency.

One of them is the complete run-down of a big tuberculosis hospital. There is a real danger that there should be carriers in the community at present and I would like to see people who have this long period of medication—18 months to two years—included in the exempted illnesses.

Mr. Kenneth Lomas (Huddersfield, West)

Would not the hon. Gentleman agree that mental illness and coronary thrombosis should also be exempted?

Mr. Harrison

Perhaps the hon. Gentleman is telepathic, because the other exciting thing in my knowledge which has happened in my area is that I have seen long-stay mental patients becoming part of the community again because so much progress has been made. There are certain types of mental illness that should probably be included amongst the exemptions. I am grateful to the hon. Gentleman for pulling me up on that point.

I now turn to the administrative arrangements. There is a possibility that the Minister is being very clever here, that the cost of administering the exemptions will be such that the saving to the Health Service through the charges will be roughly equalled by the cost of administering them.

There cannot be a chairman of any hospital management group who has not at present had to put a ceiling on recruiting of administrative staff, or, if any recruiting is done, it must be at the cost of another post in a hospital. Yet there is in the Circular, H.M. (68)30 in the Library the following instruction: When out-patient clinics are held hospitals should arrange for an officer to be available to inform patients claiming exemption whether they can be exempted or not. The additional staff that will be needed to advise patients and help them fill out their forms, and to help in the collection of the money and in making the additional records will put a very great burden on the already heavily overworked administrative staff in most of the out-patient departments in our hospitals. Various office machines will be needed, costing about £50 to £70 apiece. There will need to be two in practically every out-patient clinic, and the cost will be fairly excessive.

I hope that the Minister will consider very carefully, after the administrative arrangements have been going for a short time, whether it is possible to simplify them, to cut down their cost so that any saving through the charges will be able to go into the Service and provide a lasting benefit to it by increasing the funds available to be spent in other directions.

8.57 p.m.

The Minister of Health (Mr. Kenneth Robinson)

It may be for the convenience of the House if I intervene at this point. My hon. Friend the Under-Secretary of State for Scotland will wind up the debate and deal with those points of detail with which I cannot deal in my speech.

My hon. Friend the Member for Willesden, West (Mr. Pavitt) will not be surprised when I say that it gives me no pleasure to reply to the Prayer moved by him and supported by my hon. Friends—

Mr. J. J. Mendelson (Penistone)

My right hon. Friend has just announced that there will be two Ministerial speeches in a very brief debate. When so many hon. Members wish to speak, is it really necessary that the Government should take such a lion's share from the limited time available?

Mr. Robinson

I thought that it would be better for the House if I replied to the main principles of the debate and my hon. Friend replied to the Scottish Prayer—there are two Prayers under discussion.

Mr. Mendelson

Why not take two days?

Mr. Robinson

It is not the view of the Government, as it appears to be of the party opposite, that prescription charges are a good thing in themselves. Lest there be any doubt let me make it clear from the outset that the Government regard their reintroduction as a regrettable necessity, and it is primarily on the grounds of economic necessity that I seek to defend the making of the Regulations. I have made my view known widely, over a long period, that ideally the National Health Service should be free to everyone at the time of need, and it is not at all difficult to find telling quotations from past speeches of mine over the years.

But the ideal of a free service lasted in fact barely three years from its inception—charges of some kind have been in operation ever since 1951. It is true that before coming to office we hoped that we would in time be able to restore a completely free service, and we undertook specifically in our election programme of 1964 to abolish prescription charges. That pledge we redeemed, despite an economic situation far more adverse than anything we had contemplated, and I am glad we took the decision to do so.

Sometimes I think that some of my hon. Friends are almost implying that in the light of this decision it might have been better had we never abolished the charge in 1965. If that is so, they overlook two things. First, the obvious fact that for three years the entire public had the benefit of free prescriptions. In no other country, as far as I am aware, does this happen. Secondly, that, far from re-introducing the arrangements that obtained when we came to office, these regulations cover a wholly different system, and one which goes as far as is practicable towards exempting from having to pay all those who might find prescription charges oppressive.

Under the arrangements which we got rid of in 1965, everyone paid the charge including the chronic sick, the old-age pensioners, the children, and the expectant mothers, unless they were on supplementary benefit or their incomes were around that level, in which case they were eligible not for exemption, but for a means-tested refund, and by no means all who were entitled to a refund did in fact obtain one.

Under the scheme covered by these Regulations no fewer than 20 million people, over 40 per cent. of the population of England and Wales, will be exempt from the charge. Put another way, something like half the prescriptions issued will be dispensed free of charge. The same kind of arrangements for refund of the charge on grounds of financial hardship will operate as before, but there will be far less recourse to them, for the simple reason that many who would qualify for refund are already exempt because of age, and also because my right hon. Friend the Minister of Social Security has arranged that everyone on long-term supplementary benefit will be issued with an exemption certificate with their next order book.

I will deal with some of the detail and the specific criticism later, but this, broadly, is the scheme. Why did the Government introduce it? It formed, of course, part of the measures taken by the Government in the new year to cut back the rise in public expenditure announced by my right hon. Friend the Prime Minister on 16th January. I do not think that this is the occasion for me to justify the necessity for the £300 million cut in the programmes for 1968–69, with large savings in subsequent years. But I do not think that anybody would suggest that we cut back too much. The figure was, however, a large one by any standards, and every spending Department, including all the Social Service Departments, was called upon to contribute. It was unthinkable that Health Department, responsible as they are for about one-ninth of total Government expenditure at home and overseas, could escape.

There are, broadly, three alternatives open to a Minister of Health in this situation. Cutting back on services to patients, by abandoning in whole or in part certain specific services, like the dental or ophthalmic services, or cutting back on capital expenditure or some extension of charges to patients.

I can assure hon. Members that there is no way of securing savings of the order required by the Chancellor of the Exchequer through economies in hospital revenue expenditure. To have cut back to this extent would have meant serious curtailment of services, dismissal of staff or inability to open new hospital buildings for lack of money. This, bearing in mind that, as it is, the hospital service is under great pressure to maintain services and develop them to a modest extent on the limited rate of growth the programme permits, was something which I could not contemplate.

Nor could I envisage abandoning one or other part of our health services. The only practical alternative to an extension of charges was a cutback in the hospital building programme. It is true that we have in the last few years achieved a steady build-up in the hospital capital programme. But it has taken years to achieve this momentum and to gear all the planning and design procedures to fit in with it. Even now we are barely keeping pace with obsolescence, despite the expenditure of more than —100 million a year on hospital building. Should I have agreed to a cut-back here as an alternative to prescription charges? I doubt whether anyone who appreciates the scale of the cut that would have been needed would say that I should.

Because the expenditure on a major building scheme like a new hospital is relatively small in the first year, and probably does not reach its maximum until the third, it would have been necessary to defer the start of almost every new hospital planned to start in the next two years at least; and we need those hospitals desperately. Such a decision, quite apart from the devastating effect on morale throughout the service, would have involved a break-up of planning teams, and set back a carefully built-up and expanding programme from which we should have taken something like 10 years to recover.

Mr. William Molloy (Ealing, North)

That is a poignant argument, and a good one in the context of reducing or imposing charges, but what we are concerned about is why these charges were introduced at all. If cuts had to be made, they ought to have been made other than in the Health Service.

Mr. Robinson

Cuts were made in Social Service Departments as well as in all other Government Departments.

Were we wrong to take the view that prescription charges, with generous exemptions for those who might be hurt by them, was the preferable alternative? I can only tell the House that after three years' responsibility for this great service, I had no doubt whatever that this choice, however distasteful to me and to my right hon. Friends, was the one that did the least damage to the Health Service and its patients.

Apart from their objection to charges in principle, the main criticisms of the Regulations voiced by my hon. Friends here tonight, and elsewhere, relate to the alleged complications of the scheme, and to the arrangements for the chronic sick.

Mr. Frank Hooley (Sheffield, Heeley) rose—

Mr. Robinson

As there have been complaints about there being two Front Bench speeches tonight, I think that it will be better if I proceed with my speech.

As to the first point, the present scheme, as the House knows, has been designed as an interim arrangement, and the mechanics may possibly be altered at a later date. But the arrangements which we are now proposing could really not be much simpler, given what we are trying to achieve.

I have already mentioned that about 20 million people will be eligible for exemption. Approximately 17 million of these, or well over 80 Per cent. of the exempt categories, are eligible on age grounds, and will secure exemption from the charges merely by completing the appropriate declaration of entitlement to exemption on the back of the prescription form.

We are able to make this simple arrangement because records of their ages will be readily available for later checking. People in the other categories must first obtain an exemption certificate so that there shall be some record available of the grounds for their entitlement, but to secure exemption they then merely declare that they possess a certificate. A parent or guardian can sign the declaration for a child and a neighbour or friend collecting the medicine for a sick person may complete the declaration on his behalf.

Perhaps I might add that the scheme would have been simpler still but for the very welcome arrangement which my right hon. Friend the Minister of Social Security has been able to work out, whereby large numbers of people receiving supplementary benefit can be exempted from paying the charge, instead of having to pay and then seek a refund as they used to when charges were in force before. Here we are doing much better than was envisaged when the decision was announced in January.

I might also mention that we are doing better in that it has not been necessary, as we once thought it might be, to reintroduce the charges in the first place merely with refund arrangements, leaving exemption to be provided for later when my discussions with the professions were complete. In the event, we were able to hold back the reintroduction of the charges for a short time so that the exemption arrangements could be operated simultaneously, just as my hon. Friends pressed me to do.

The procedure for obtaining exemption certificates will be straightforward. The Ministry of Social Security will be able to issue them for many of those for which they are responsible without any application having to be made, and, although applications will be required for certificates issued by Executive Councils, we have again made the procedure as simple as we can. These arrangements have been worked out in conjunction with the medical and pharmaceutical professions. Extra burdens will fall on the members of both professions—chemists, in particular, have a vital part to play, since it is to them that the charges have to be paid by those, of course, who are not exempt—and also on Executive Councils. I am grateful to all concerned for their co-operation.

I am particularly anxious that people should exercise to the full their entitlement to exemption or refunds. It is no use giving people rights if they do not use them. I agree that, at first sight, the scheme looks a bit complicated— these things always look more complicated in Regulations—but this is because we are exempting so many categories. In fact, the procedure for each category is quite simple—for the largest ones, the old and the young, very simple indeed— and this should help.

We are doing all we can to ensure that people understand how the scheme works. We are making use of broadcasting—I explained the scheme on television last week—and large advertisements are being inserted in the national and provincial Press. That is the answer to the hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers). Explanatory leaflets are available in post offices, and there are notices for display in doctors' surgeries and chemists' shops. I shall, of course, be keeping a watch on the position as it develops after 10th June, so that further steps can be taken if need be; but I hope that enough has been done to ensure that the public are properly informed.

My hon. Friend the Member for Willesden, West asked about cost. He asked, first of all, what was the cost of checking. We think that this will probably be between —50,000 and —70,000 a year. The cost of the Press campaign and publicity is about —70,000. It is difficult to say what the number of additional hospital staff will be, but it will certainly be very small.

As to the average running costs, he seemed to be confusing two things. He quoted a figure which had been mentioned as the initial cost of the proposed longer-term scheme, which is still under consideration, but this was nothing to do with the running costs. The estimate which I would give of the running costs of the present scheme is about —250,000 a year, which is about 1 Per cent. of the total saving.

In devising these arrangements, the greatest difficulties arose over the chronic sick. This we had always foreseen; and it was always made clear that there could be no certainty, until we had had discussions with the professions, that it would in fact be possible to make exemption arrangements for this category, however much we wished to do so.

The House will accept, I am sure, that, when it comes to identifying a chronically ill patient, only the doctor can do it. At first, the representatives of the medical profession who were appointed to discuss this problem with us stated firmly that general practitioners were unwilling to do this at all. In case some hon. Members read into this an attitude of non-co-operation with the Government, let me say I do understand their reluctance. No doctor is anxious to differentiate between one patient and another to determine who shall pay and who need not, particularly where judgment would have to be largely subjective. The doctors represented to me that such a situation would lead to endless argument with patients, and would seriously impair the doctor-patient relationship.

We tried very hard together to discover objective criteria for defining the chronic sick in the wider sense, but we were not successful in finding any formula which satisfied the doctors. Eventually, however, after prolonged negotiation, we did agree on a list of conditions which, because it relied on medical fact rather than judgment, avoided the difficulties which I have described. The categories are, I admit, narrower than I would have wished, but to widen them was quite unacceptable to the profession for the reasons I have given. We always knew, I repeat, that we could exempt the chronic sick only to the extent that their family doctors were willing to identify them.

Hence the somewhat cautious wording of my right hon. Friend the Prime Minister's original statement. I must tell my hon. Friend the Member for Willesden, West that it could not have been an "undertaking"—the word he used. In fact, we have done better than at one time looked possible, and I am satisfied that this perhaps rather narrow definition of the chronic sick is the best that could be arrived at.

The overall result was that about 20 million people will be entitled to exemption. This, I think, is an impressive figure. It is true that, even so, there may be instances of hardship—though we must remember that there will be refund arrangements as a fall-back. Some would argue that, in any scheme involving entitlements, a line must be drawn somewhere, and that some people whom one would wish to help will come just on the wrong side of the line.

This is true; but there is one category of patient which, though not a very large one, I am particularly anxious to help. It consists of patients who are not chronically ill within the definition agreed for this purpose, but who do need unusually frequent prescriptions. I am thinking here of patients suffering from chronic conditions, including psychiatric disorders which may call for regular drug treatment over considerable periods and also of the person—for example, the man has bronchitis regularly in the winter —who may not need continuous medication, but who requires numerous prescriptions at intervals. This group includes almost all sufferers from those conditions and illnesses so far mentioned in this context in this debate.

We have not been able to exempt them completely, and I have explained why; but we intend to help them by enabling them to buy for a sum representing the cost of, perhaps, two prescriptions a month, a rate of Is. 3d. a week, an exemption certificate for a fixed period. The Health Services and Public Health Bill, which will be coming back to this House fairly soon, has been amended in another place to give me the necessary powers for this. If this new Clause is agreed, I shall in due course be making Regulations dealing with the purchase of these certificates.

This cannot be done at once, because the Bill is not yet on the Statute Book. There will be some practical problems to solve, but I want to introduce the arrangements as soon as I can, and I want particularly to see them operating by the winter.

Given the need for prescription charges, I think that our aim to ensure that they will operate so as to be socially just has been broadly achieved—though I do not pretend that these charges will be welcomed by those who have to pay them. What charges ever are? But all the indications are that the public understands why we have had to take this step, and accepts it.

I know how my hon. Friend the Member for Willesden, West feels about these Regulations. He spoke of the Health Service in terms which certainly moved me and, I think, moved the whole House. On this issue he has fought a long and valiant fight. I hope that when we reach the end of this debate he and my other hon. Friends will not feel it necessary to carry their opposition to these Regulations to a Division.

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